1988, 09-24 Permit App: 88003029 Furnace, PipingMECHANICAL PERMIT APPLICATION WORKSWEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
I certify that the above information as submitted by me is true and correct and further, agree that all pro-
visions of laws and ordinances governing this type of work, including inspection requirements, will be com-
plied with whether specified herein or not. The granting of a permit does not presume to give authority to
violate or cancel the provisions of any state of local laws regulating construction or the performance of
construction.
SIGNATURE 0
OWNER OR
APPLICATION q a
DATE L�
Project #
Owner's Name Last FirstMI
Project Address (Street Name & Number
—1 1 L3 — 9" is.v-ei
City f^
State
SutxlivisionlPlatName
Assessors Parcel #
Lot
Block
Plat #
Applicant
1 •-5(1-1,e....\\ -162_ �. N U
Address
\C--- j 6a3 L 3 --7-1-' ,q -k,
City
(___-)60
State
WC
ip
I�ao3
Phone
63S-- kl_S
Business Phone
3& 1 -1,,S -a3
Contractor``
Addres
fA
City c._�
State
Uj C37a.�3
Phone
- — 4;a3
Cont V
a I. ' •, C -stl.C%
License #
e#
lA -P.ZV G%9Gam-
Business Phone
-LILs---c93
Describe Worlt
Fans
Evaporative Cooler
Hoo
Electric Furnace/Ducts
Miscellaneous
Dryer
Range
Gas Log
Gas Water Htr.
Solid Fuel/Wood Stove
Air Handling Units
0-10,000 CFM
10,000 + CFM
Refrigeration Systems/
Heat Pumps (BTU)
1-100M
101-500M
501-1,000M
1,001-1750M
Over 1750M
r
Compressor
0-3HP
3-15HP
15-3OHP
30-5OHP
50+HP
Gas Piping
1-5 Outlets
6 + Outlets
Gas Fired Heating System
1-100,000BT
10,,,.;00+BTU
I certify that the above information as submitted by me is true and correct and further, agree that all pro-
visions of laws and ordinances governing this type of work, including inspection requirements, will be com-
plied with whether specified herein or not. The granting of a permit does not presume to give authority to
violate or cancel the provisions of any state of local laws regulating construction or the performance of
construction.
SIGNATURE 0
OWNER OR
APPLICATION q a
DATE L�